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To look up a health care term such as Actuary, choose the letter that the term begins with below under Alphabetical Glossary. This will take you to the terms beginning with that letter. To look up a health care acronym such as AIDS, choose the letter that the term begins with below under Acronyms. This will take you to all acronyms that begin with that letter.

Scope of Benefits or Coverage	Refers to the range of services, providers, and settings covered by a health benefit plan.
Scored Savings	Amount of savings expected to be obtained from enacting new legislation. The Congressional Budget Office makes official estimates by calculating the difference in spending projected under current law and under the proposed legislation.
Screening	The method by which managed care organizations limit access to health care for unnecessary reasons. In most HMO's, a phone call to the physician or his or her medical office staff is required before an office visit can be arranged. "Gatekeepers" and concurrent review are other methods of screening patients.
Second Opinion Program	Voluntary or mandatory medical or surgical review program established by a health benefit program to ensure the medical necessity of proposed services or procedures. The second opinion is paid for by the plan and provided by a physician other than the professional recommending the treatment. Payment for care is usually assured under the benefit program regardless of the second opinion recommendation if the patient obtains the second opinion in accordance with the health benefit requirements. Coverage limitations may be imposed upon beneficiaries not complying with mandatory programs. Second opinion programs may be required for inpatient and for ambulatory services and procedures. These programs may be considered a cost containment mechanism as well as a means to help ensure the medical necessity of proposed services.
Secondary Care	Services provided by medical specialists, such as cardiologists, urologists and dermatologists, who generally do not have first contact with patients.
Secondary Coverage	The plan that has the responsibility for payment of any eligible charges not covered by the primary coverage.
Selective Contracting	The practice of a managed care organization (MCO) by which the MCO enters into participation agreements only with certain providers (and not with all providers who qualify) to provide health care services to health plan participants as members of the MCO's provider panel.
Self-Administered Plan	Health benefit plan administered by the employer or health and welfare fund rather than through an insurance carrier or third party administrator.
Self-Funding	Often confused with self-insurance, a self-funded health care plan is funded entirely by the employer. A self-funded plan may be self-administered, or the employer may contract with an outside administrator for an administrative services only arrangement. Self-funded plans obtain stop-loss insurance to cover catastrophic illnesses.
Self-Insurance	The practices of an employer or organization assuming complete responsibility for health care losses of its employees. This usually includes setting up a fund against which claim payments are drawn and claims processing is often handled through an administrative service contract with an independent organization.
Self-Insured	Employers who assume direct responsibility or risk for paying for employees' health care without purchasing health insurance. They usually contract with an outside firm to handle claims payment and/or utilization review.
Self Referral	Arrangements for care beyond primary care made by the patient rather than the provider. HMOs generally specify to which in-house departments or services a patient may self refer. Physicians self-referral is when providers refer patients to a facility in which they have a vested interest.
Sentinel Event	An adverse health event that may have been avoided through appropriate care or alternative interventions. Providers are required to alert JCAHO and often state licensing authorities of all sentinel events, including a review of risk factors, preventative measures and case analysis.
Service Area	The geographic area serviced by the health plan as approved by the state regulatory agencies and/or detailed in the certification of authority.
Service Guideline	A type of practice guideline that presents the appropriate and inappropriate indications for the use of particular diagnostic and therapeutic procedures.
Service Substitution	Use of lower cost, but still effective, service in place of a higher cost service.
Severity Modifier	An adjustment that reflects patient factors, such as severity of illness, morbidity, or risk of complications, on the relative work required to deliver a service.
Shared Risk	An arrangement in which financial liabilities are apportioned among two or more entities. For example, an HMO and the medical group may each agree to share the risk of excessive hospital cost over budgeted amounts on a 50/50 basis.
Shared Savings	A provision of most prepaid health care plans where at least part of the providers' income is directly linked to the financial performance of the plan. If costs are lower than projections, a percentage of these savings are referred to the providers.
Single Contract	Coverage for one person as designated on the enrollment or enrollment change card by the enrollee.
Single Payer	A proposed Federally sponsored universal health insurance coverage to all Americans. Employers would not be required to offer health insurance to their employees. Health insurance companies would not exist in the same capacity as they do today. The Government would establish payment rates for physicians, hospitals and other medical services.
Single Payer System	A system in which everyone is covered under a publicly run health insurance program under which the government or some other single entity serves as the sole source of payment for a broad range of health care services.
Site-of-Service Differential	The difference in the monies paid when the same service is performed in different practice setting or by a different provider. One example would be an examination in an energency room (ER) versus in a family doctor's office.
Skilled Care	That level of care which: requires the training and skills of a Registered Nurse; and is prescribed by a doctor for the medical care of the patient; and may not be provided by less skilled or less intensive care, such as custodial care or intermediate care.
Skilled Nursing Facility (SNF)	A facility, either freestanding or part of a hospital, that accepts patients in need of rehabilitation and medical care that is of a lesser intensity than that received in the acute care setting of a hospital.
Small Employer Health Insurance Availability Act	In 1994 the General Assembly enacted modifications to the act expanding its scope to firms with 1-50 employees (previously 2-25 employees).
Small Group Market	Measures aimed at alleviating problem areas in the private insurance marketplace, including guaranteed issuance of policies; limitations or prohibitions on benefit plan limitations or exclusions for preexisting health conditions and an end to experience rating.
Small Group Pooling	All segments of small group businesses when combined into a pool or pools. Claims are determined by a pool and not on a group-specific basis.
Small Market Insurance Reform	Changes in the marketing of insurance to small businesses that increase the availability and affordability of coverage.
Social HMO (S/HMO)	Demonstration HMO under Medicare that provides capitated acute and primary care as well as limited long term care coverage to a broad cross section of the elderly population on a voluntary basis. Enrollees are mostly private pay and generally benefit from lower cost sharing than in traditional fee for services Medicare, thereby eliminating the need for Medigap policies. Also see health maintenance organization, Medicare, and Medigap.
Social Security Act	Law that created Medicare,Medicaidand other Federal programs under the following titles: II = Old Age, Survivors and Disability Insurance Benefits (Social Security or OASDI). IV -A = Aid to Families with Dependent Children (AFDC). IV-B = Child Welfare IV-D = Child Support IV-E - Foster Care IV-F = Job Opportunities and Basic Skills Training V = Maternal and Child Health Services XV = Supplemental Security Income (SSI) XVIII = Medicare XIX = Medicaid XX = Social Services Block Grant (SSBG) XXI = Child Health Insurance Program (CHIP)
Social Security Administration	The administrative branch of the Federal government established in 1935 to provide old age and survivor benefits.
Social Service Block Grant (SSBG)	Flexible Federal grant program established under Title XX of the Social Security Act to fund non-medical services for low income persons including some long term care services. Financial eligibility is usually more liberal than Medicaid.
Social Worker	Performs duties directly related to the health of the individual and the family in psychiatric and medical social work. Completion of a baccalaureate degree.
Socialized Medicine	Seesingle payer system.
Sole Community Hospital (SCH)	A hospital which (1) is more than 50 miles from any similar hospital, (2) or is the exclusive provider of services to at least 75 percent of its service area populations or (3) has been designated as an SCH under previous rules. The Medicare DRG program makes special optional payment provisions for SCHs, most of which are rural, including providing that their rates are set permanently so that 75 percent of their payment is hospital-specific and only 25 percent is based on regional DRG rates.
Special Imaging Technician	Proficient in two of the diagnostic procedures, i.e., nuclear medicine, radiology, ultrasound or CT scan. Must fulfill the specific requirements for each of the two selected specialties.
Special Risk Insurance	Coverage for risks or hazards of a special or unusual nature.
Specialist	A physician who has special experience and expertise in a portion of the medical field. In most instances specific credentials, including residency placement and board certification must be acquired in order to qualify as a specialist.
Specialty Differential	The difference in the relative value or amount paid for the same service when performed by physicians in different specialties.
Specialty HMO	An HMO organized around a specific medical specialty, such as cancer or cardiac care.
Specified Disease Insurance	Insurance providing benefits, subject to a maximum amount, for expenses incurred in connection with the treatment of specified diseases, such as cancer.
Specified Low Income Medicare Beneficiaries (SLMB)	Medicare premiums (but not cost sharing) paid by Medicaid on behalf of certain low income eligibles. Also see qualified Medicare beneficiary.
Speech Therapist (ST)	Speech therapist are trained to evaluate and improve speech and community functioning.
Spend Down	Procedure whereby Medicaid applicants use a portion of savings and other resources on medical expenses in order to meet Medicaid resource eligibility requirements. Can also apply to income spend down for states with a medically needy component to Medicaid (currently not available in Delaware). Also see medically needy.
Sponsor	An organization which selects and manages the choice of health insurance products for a group of individuals. Sponsors include employers, government and quasi-public organizations established to manage insurance choice (e.g., HIPCs).
Spousal Discount	A premium reduction, usually from 10% to 25% of the premium, that some insurers provide when both a wife and husband purchase long-term care policies. Insurers offering such discounts sometimes do so for two people who permanently reside together whether or not they are spouses.
Staff Model HMO	An HMO that delivers health services through a group in which physicians are salaried employees who treat HMO members exclusively.
Staff Nurse	Performs a variety of professional nursing care duties including evaluating and recording physical and emotional conditions, reporting changes observed to charge nurse or physician, gives and receives reports on each patient, administers prescribed medications orally, by intramuscular injection and by intravenous fluids as ordered, starts and monitors blood transfusions, has knowledge of patients at all times.
Standard Benefits Package	Also referred to in some plans as minimum benefits or uniform benefits, this would include the basic package of preventive and acute care benefits to be offered by all health plans. The standard benefits package may be defined in terms of specific services or in terms of services to be included and excluded, allowing health plans to determine which services are rendered on the basis of appropriateness and medical necessity. The generosity of the standard benefit package will be a key political decision and will have wide ranging implications in terms of program costs, public support, and services available to previously uninsured populations.
Standard Class Rate (SCR)	A base revenue requirement on a per member or per employee basis, multiplied by group demographics information to calculate monthly premium rates.
Standing Referral	A referral to a specialist provider that covers routine visits to that provider. It is a common practice to permit the gatekeeper to make referrals for only a limited number of visits (often 3 or fewer). In cases where the circumstances requires regular visits to a specialist, this type of referral eliminates the need to return to the gatekeeper each time the initial referral expires.
Stark II	The commonly used name for Federal laws and regulations that ban physician referral to entities with which the physician has a financial relationship.
State Defined Plan	An HMO that is not Federally qualified but meets state requirements to contract on a full-risk capitation basis for Medicaid enrollees.
State Mandated Benefits Laws	State laws requiring insurance contracts to provide coverage for certain health services (e.g., in vitro fertilization) or for services provided by certain health care providers (e.g., audiologists). Self-insureds are exempt from these requirements. There are over 800 mandates nationwide.
State/Private Insurer Long-Term Care Partnerships	Arrangements between some states and certain private insurance companies to provide long-term care insurance. Subject to the specific legal requirements for each state, these partnerships help protect the assets of enrollees who typically must become nearly impoverished before qualifying for Medicaid assistance for long-term care costs. In general, the state approves the long-term care policies offered by insurers who agree to include state-mandated provisions. Enrollees who purchase the approved policies may protect one dollar in assets for every one dollar in benefits paid by the private insurance coverage. The purpose of these plans is to shift some of the burden for long-term care from Medicaid programs to private insurance while at the same time allowing insurance purchasers to keep assets they would otherwise have to spend in order to qualify for Medicaid when the private insurance benefits are exhausted.
State Unit on Aging (SUA)	State Units on Aging are agencies of state government designated by the governor and state legislature as focal points for all matters relating to the needs of older persons within the state. The SUA is responsible for planning, coordinating, funding, and evaluating programs for older persons authorized by both state and Federal governments. The SUA aims to improve the quality of life for older Americans by advocating on their behalf, and by promoting the development of community-based systems of social and health services. Also see area agency on aging.
Statute	Rules defined in law. Statutes are issued by legislative authority of the Federal or state government. Also see regulation.
Stop Loss	Agreed upon point beyond which a managed care organization is no longer liable for costs. Also see risk and risk coordinator.
Stop Loss Insurance	Describes two aspects in insurance. The policyholder may be protected by a ceiling on the amount that must be paid out-of-pocket for deductibles and co-insurance for covered services and allowable charges in a policy year. A health plan may purchase insurance to protect the plan against costs that exceed specified levels.
Subacute Care	Care given to patients who require less than a 30-day length of stay in a hospital and who have a more stable condition than those receiving acute care.
Sub-Capitation	Capitation for a limited set of medical services. Also see pre-paid health plan.
Subrogation	The recovery of the cost of services and benefits provided to the enrollee of one MCO when other parties are liable.
Subscriber	The person responsible for payment of premiums or whose employment is the basis for eligibility for members in an HMO or other health plan.
Subscriber Contract	A written agreement, which may also be called a subscriber certificate or a member certificate, describing an individual's health care policy.
Summary Plan Description	A description of the entire benefits package available to an employee as required to be given to persons covered by self-funded plans.
Superbill	A modified claim form that lists specific and/or specialty medical services provided by a physician.
Supplemental Medical Benefits	Health care reform plans normally allow the acceptance of supplemental benefits, which are normally not covered by a standard benefit package. These include services not usually medically necessary such as organ transplant, or enhanced psychiatric services. Consumers would have to pay an additional premium for these benefits.
Supplemental Medical Insurance	Private health insurance, also called medigap, designed to supplement Medicare benefits by covering certain health care costs that are not paid for by the Medicare program.
Supplemental Security Income (SSI)	A Federal program of income support for low income, aged, blind and disabled persons established by Title XVI of the Social Security Act. Qualification for SSI often is used to establish Medicaid eligibility.
Supplemental Services	Optional services that a health plan may cover or provide in addition to its basic health services.
Supports	Term used in the disability community to refer to a service that promotes independence and does not treat the individual as a passive recipient of care.
Surgicenter	A separate, freestanding medical facility specializing in outpatient or same-day surgical procedures. Surgicenters drastically reduce the costs associated with hospitalizations for routine surgical procedures because extended inpatient care is not required for the specific disorders treated by them.
Survey and Utilization Reviews (SURS)	Medicaid unit that reviews claims and utilization to ensure that Medicaid funds are being used appropriately.
Swing Beds	Acute care hospital beds that can also be used for long-term care.